1. Field of the Invention
The field of this invention is surgical procedures, particularly endoscopic surgical procedures, involving the use of multiple sutures and devices to keep suture strands bundled until tied to prevent tangling.
2. Description of the Prior Art
Endoscopic surgery and, in particular, arthroscopic surgery often involves working in confined spaces while trying to embed suture anchors, penetrate soft tissue and tie off sutures. It will be understood that, generally, a suture extends through an eyelet at the proximal end of an anchor (embedded in bone) such that the suture is folded back on itself at some point between the suture ends. The part of the suture at which it is folded back on itself will sometimes be referred to herein as the bight portion. At least one of the ends is passed through tissue and is tied to the other end to anchor the tissue. Certain procedures such as rotator cuff and instability require numerous sutures, which sometimes are not tied off after being placed through tissue. The need to delay tying-off occurs to enhance visibility at a crowded work site and because subsequent sutures are more easily placed if previous adjacent sutures are not tied off at that time. The problem that occurs, without the present invention, is the management of associated pairs of suture ends for ultimate tying-off. While different colors can be used for sutures to distinguish them on a scope, the confined space and the limit of the colors available make it difficult to match two ends of a given suture that may be intertwined with ends of an unrelated suture.
When repairing rotator cuffs, anchors are placed in the bone, sometimes as many as five, and each suture (attached to a given anchor) has its ends taken out the cannula to be tied at the end of the operation. This technique has the benefit of not closing the torn tendon down to bone too early or too tightly, thereby making it easier to pass the stitching tool under the tendon. Larger anchors have been developed, doubling the number of sutures to manage since each anchor can accommodate two sutures. With larger suture anchors having so many sutures, it is difficult to wait until the end of the procedure before tying the sutures. A technique was developed to allow tying the sutures throughout the surgery. Although this technique worked well, it had two major drawbacks. First, once a suture is tied down it is more difficult to pass the rest of the stitches. Also, each time a pair of suture ends is passed the surgeon has to turn off the pump, move the scope, turn the pump back on, clean the blood out of the bursa and then tie the next set of sutures. It would save time and be much more efficient if the sutures could all be tied at once, at the end of the case. Without the present invention, it is difficult to wait to the end of the case because management of suture end pairs for proper tie-off is difficult.
In addition to managing sutures during rotator cuff surgery, there was also a need to manage them while doing instability surgery. During that operation two or three sutures are placed in the back of the shoulder at the beginning of a case but are not tied until the end of the case. When the anterior portion of the reconstruction is finished and the surgeon returns to the back of the shoulder to tie the suture, it is often difficult to determine which suture pairs go together, since there are four to six sutures present coming out of the portal. Sometimes the suture strands are twisted one on the other, making for a very confusing situation.
In the past, sutures were packaged in multi-suture holders but these products merely organized discrete sutures until the surgeon needed them in a procedure. Examples of such suture packaging are shown in U.S. Pat. Nos. 5,123,528; 5,413,214; 5,848,714 and 5,566,822. These devices had no suture management capabilities when the sutures were taken out and used in a procedure (in an anchor, for example). Somewhat more relevant were anastomosis catheters which separated individual sutures until a suture needle was pushed out of a respective slot in the catheter to grab the tissue (for example, urethra). Examples of such devices are U.S. Pat. Nos. 5,545,171 and 6,080,167. These devices were designed with a specific procedure in mind and had to have all the sutures organized in discrete passages before the catheter was inserted in the patient. They were not adapted to manage untied sutures during a procedure that needed to be tied off at a later time.
An objective of the present invention is to simply provide such a suture management system to avoid mix-ups of unmatched pairs of sutures being tied together. Another objective is to have the suture organizers assembled in a rack and to provide them in a variety of colors to make them readily accessible and distinguishable on a scope.